What do healthcare professionals think about healthcare delivery for older housebound patients? Survey findings (CHiP study).

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

6E.2

Presenter:

Polly Duncan

Twitter:

@capcbristol

Co-authors:

Polly Duncan[1], Nathan Yung[1], Beth Winn[1], Madeleine Kissane[1], Samuel WD Merriel[2], Thomas Brain[1], Victoria A Silverwood[3], Ishbel Orla Whitehead[4], Laura Howe[1], Chris Salisbury[1], Rupert Payne[5] on behalf of the Primary Care Academic CollaboraTive (PACT)

Author institutions:

[1] University of Bristol, [2] University of Manchester, [3] Keele University, [4] Newcastle University [5] University of Exeter

Problem

Older housebound patients are an under-researched group, with high rates of physical and mental health problems and social deprivation (~340,000 older housebound in the UK). From 2007-2014, GP consultations increased by 14%, but home visits decreased by 6.5%; and in 2019, GP representatives voted to remove home visits from the GP contract, citing lack of capacity and calling for a separate urgent visiting service. Implicitly, this casts the housebound as having predominately acute needs, and risks a failure of proactive, anticipatory care. COVID-19 further changed primary healthcare delivery. We aimed to explore HCP views on healthcare for older housebound patients and impact of COVID-19.

Approach

This study was delivered by the ‘Primary care Academic CollaboraTive’ (PACT) – an initiative that aims to build academic primary care capacity through engaging trainees and healthcare professionals (HCPs) in research, hereafter referred to as PACT members. Data were collected during April-October 2023 in England. PACT members completed a survey about organisation of healthcare for older housebound patients in their practice and recruited a further 2-4 HCPs from their practice to complete a separate survey exploring HCP’s views about healthcare for older housebound patients. HCPs were asked to what extent they agreed or disagreed with eleven statements (5-point Likert scale from strongly agree to strongly disagree).

Findings

Seventy-eight practices participated, with 261 HCP surveys completed (response rate 84%; 58% female; 65% GPs, 12% paramedics, 11% nurses, 12% other). In half the practices, GPs completed the most home visits; in 30% paramedics completed the most. Most HCPs (88%) agreed their practice offered home visits for urgent problems but only 68% for non-urgent problems; 72% had protected time for home visits. Seventy percent agreed their practice offered proactive anticipatory care for older housebound patients and 31% agreed phone calls/home visits were frequently initiated by the practice. Almost a third agreed COVID-19 negatively impacted healthcare for older housebound patients; number of home visits decreased, and they had less time for home visits. Thirty-six percent agreed a significant proportion of home visits had been replaced by phone/video calls and 89% agreed older housebound patients had more problems with technology.

Consequences

Recruitment targets were exceeded, with a high response rate and a good range of HCPs. Paramedics completed most home visits in almost a third of practices, reflecting workforce diversification. Importantly, many HCPs did not have protected time for home visits and in many practices home visits were not offered for non-urgent problems. A third of HCPs reported that COVID-19 had a negative impact on housebound patients – home visits fell and a significant proportion were replaced by phone/video calls. This study provides evidence to policymakers that healthcare for older housebound patients is suboptimal. Further research is planned to redesign healthcare for this important group.

Submitted by:

Polly Duncan

Funding acknowledgement:

Care of Housebound patients in Primary care (CHiP study) was funded by the Royal College of General Practitioners (RCGP) Scientific Foundation Board (SFB 2019-14) and Dr Duncan’s NIHR Doctoral Research Fellowship (NIHR301824). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or the RCGP.